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Disparities in minimally invasive surgery for colorectal cancer in Florida
Osayande Osagiede1, Aaron C Spaulding2, Jordan J Cochuyt2
1Department of Surgery, Mayo Clinic, Jacksonville, FL, USA.
Background:
The cost of minimally invasive surgery (MIS) raises potential for racial and social disparities. The aim of this study was to identify the racial, socioeconomic and geographic disparities associated with MIS for colorectal cancer (CRC) in Florida.
Methods:
Using the Florida Inpatient Discharge Dataset, we examined the clinical data of patients who underwent elective resections for CRC during 2013-2015. Multivariable analysis was performed to identify differences in gender, age, race, urbanization, region, insurance and clinical characteristics associated with the surgical approach.
Results:
Of the 10,224 patients identified, 5308 (52%) had open surgery and 4916 (48%) had MIS. Females (p = 0.012), Medicare-insured patients (p = 0.001) and residents of South Florida were more likely to undergo MIS. Patients with Medicaid (p = 0.008), metastasis (p < 0.001) or 3-5 comorbidities (p = 0.004) had reduced likelihood of MIS. Hispanic patients in Southwest Florida had reduced likelihood of receiving MIS than whites (p < 0.017). Patients who underwent MIS had significantly reduced LOS (p < 0.001).
Conclusions:
Consistent with national studies, MIS for CRC in Florida is associated with insurance status and geographic location. There are patient-level regional differences for racial disparities in MIS for CRC in Florida.
Insights
Minimally invasive surgery (MIS) for colorectal cancer (CRC) in Florida shows disparities. Insurance and location impact MIS use, with racial differences noted in specific regions, affecting patient outcomes.
Area of Science:
- Oncology
- Surgical Innovation
- Health Disparities Research
Background:
- Minimally invasive surgery (MIS) for colorectal cancer (CRC) may exacerbate existing racial and socioeconomic disparities due to cost.
- Understanding these disparities in Florida is crucial for equitable healthcare access.
Purpose of the Study:
- To identify racial, socioeconomic, and geographic disparities in the utilization of MIS for colorectal cancer (CRC) in Florida.
- To analyze factors influencing the choice between open surgery and MIS for CRC treatment.
Main Methods:
- Analysis of the Florida Inpatient Discharge Dataset for elective colorectal cancer (CRC) resections between 2013-2015.
- Multivariable analysis to identify associations between patient demographics, insurance, geographic location, clinical characteristics, and surgical approach (open vs. MIS).
Main Results:
- Of 10,224 patients, 48% underwent MIS. Females, Medicare patients, and South Florida residents were more likely to receive MIS.
- Medicaid patients, those with metastasis, or multiple comorbidities had reduced MIS likelihood.
- Hispanic patients in Southwest Florida showed a reduced likelihood of MIS compared to white patients. MIS was associated with a significantly shorter length of stay (LOS).
Conclusions:
- Minimally invasive surgery (MIS) for colorectal cancer (CRC) in Florida is significantly associated with insurance status and geographic factors.
- Patient-level regional variations contribute to racial disparities in MIS utilization for CRC within Florida.
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